JCS Student Health Record - Jogjakarta Community School

info@jogjacommunityschool.org +62 811 257 6164

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Student Health Form

JCS Student Health Form

JCS STUDENT HEALTH

JCS STUDENT HEALTH RECORD

Please ensure that the School Office is informed of any changes to your child's Health Record

Student Full Name

Blood Group

Drug / food allergies

Doctor Name

Mobile Phone

Please answer the following questions

Does your child suffer from congenital conditions (i.e G6PD, Thalassemia, Hemophilia, congenital heart conditions, cystic fibrosis)?

Yes

Please provide details:

Does your child have any other specific illness (i.e epilepsy, asthma, kidney, diabetes)?

Yes

Please provide details:

Does your child have any allergies (i.e food, insects, medication)? How do these allergies usually present, and how are they usually treated?

Yes

Please provide details:

Does your child have any problems with vision, hearing or speech (i.e wear glasses, contacts, ear tubes or hearing aids)?

Yes

Please provide details:

Has your child had any hospitalisation, operation or major illness?

Yes

Please provide details:

Has your child had any significant injury or accident?

Yes

Please provide details:

Does your child take any medication?

Yes

Please provide details:

Does your child have any limitation on physical activity?

Yes

Please provide details:

Thank you for completing your child's JCS enrolment form. The School Office will also require the following original documents to finalise the enrolment:

Birth certificate or passport
Immunisation record
Academic report from the last school attended

Online Trial/Registration Form
Student Enrolment Form
Combined Permission Form

Jogjakarta Community School (JCS)
Jl Watugede, Mudal, Sariharjo, Ngaglik, Sleman, Yogyakarta, Indonesia 55581.
info@jogjacommunityschool.org
+62 811 257 6164